Business Analyst (Healthcare Claims / Program Integrity)

Reveal Global Consulting LLC; Scaggsville (MD); On-site; USD 85,000 - 115,000; Full time

Benefits offered by this job

Medical Plan

Vision Plan

Life Insurance

Disability Insurance (Short/Long-Term)

401K Retirement Plan

Flexible Spending

EAP

Paid time off

Job summary

Reveal Global Consulting LLC in Fulton, MD is seeking a Business Analyst to bridge auditors and AI teams for healthcare claims and program integrity projects. You will gather requirements, document workflows, and manage AI-enabled analysis, with strong emphasis on Jira-managed Agile sprints and user acceptance testing.

The role requires practical experience with healthcare provider data, SQL querying, and ability to navigate data governance while delivering clear documentation and training

Qualifications

• Bachelor's degree in business, healthcare administration, public health or a related field.
• 4+ years as a business analyst or in a related role.
• Experience with healthcare claims investigations or audits (e.g., SIU or program integrity).
• Hands-on experience with healthcare provider data (NPI, taxonomy, enrollment, affiliations).
• Working knowledge of SQL for querying and analyzing claims data.
• Understanding of claims data and common fraud, waste and abuse schemes.
• Experience with Jira and running Agile sprints.
• Experience using AI agents or tools to speed up requirements and documentation work.
• Strong facilitation, meeting-minute and requirements documentation skills.
• Able to pass a federal background investigation.

Responsibilities

• Work with auditors and investigators to find and prioritize AI use cases.
• Gather and document business requirements, workflows and success measures.
• Use AI agents and tools to draft and refine requirements documents, user stories and acceptance criteria.
• Take clear, accurate meeting minutes and track decisions and action items.
• Map current audit and investigation processes and point out where AI can add value.
• Manage the backlog in Jira and help run sprint planning, reviews and retrospectives.
• Support user acceptance testing and evaluation of AI outputs, and collect user feedback.
• Write user guides and training materials, and help lead training sessions.
• Keep stakeholders up to date on progress, decisions and open questions.

Skills

SQL queries

Requirements documentation

Facilitation

Meeting minutes

User stories

AI tools usage

Backlog management

Education

Bachelor's degree in business/healthcare

Tools

Jira

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Business Analyst (Healthcare Claims / Program Integrity)

Full Time Fulton, MD, US

About the role
We support a federal agency in bringing generative AI into its healthcare oversight work. You'll be the link between auditors and investigators and our AI team: turning their needs into clear use cases and requirements, and making sure the solutions fit into their daily workflow.

What you'll do

• Work with auditors and investigators to find and prioritize AI use cases
• Gather and document business requirements, workflows and success measures
• Use AI agents and tools to draft and refine requirements documents, user stories and acceptance criteria
• Take clear, accurate meeting minutes and track decisions and action items
• Map current audit and investigation processes and point out where AI can add value
• Manage the backlog in Jira and help run sprint planning, reviews and retrospectives
• Support user acceptance testing and evaluation of AI outputs, and collect user feedback
• Write user guides and training materials, and help lead training sessions
• Keep stakeholders up to date on progress, decisions and open questions

Required

• Bachelor's degree in business, healthcare administration, public health or a related field
• 4+ years as a business analyst or in a related role
• Experience with healthcare claims investigations or audits, such as a payer Special Investigations Unit (SIU), a program integrity team or claims/provider audit work
• Hands-on experience with healthcare provider data (e.g., NPI, taxonomy, enrollment, affiliations)
• Working knowledge of SQL for querying and analyzing claims data
• Understanding of claims data (CPT/HCPCS, ICD-10, NDC codes, member data) and common fraud, waste and abuse schemes
• Experience with Jira and running Agile sprints
• Experience using AI agents or tools to speed up requirements and documentation work
• Strong facilitation, meeting-minute and requirements documentation skills
• Able to pass a federal background investigation

Nice to have

• Certifications such as AHFI or CFE
• Exposure to AI or analytics projects

We offer a competitive and comprehensive benefits package that includes the following:

• Medical/Prescription Drug Plan
• Vision Plan
• Basic Life Insurance
• Short Term Disability Insurance
• Long-Term Disability Insurance
• 401K Retirement Plan
• Flexible Spending
• Employee Assistance Program (EAP)
• Paid time off and Holidays

If you are eager to become part of our team, and make a difference through impactful projects, don't miss this chance!

Reveal Global Consulting is an Equal Opportunity Employer. We believe that every employee has the right to be treated with dignity and respect. Consequently, we will not discriminate based on age, race, creed, color, sex, national origin, citizenship, disability, marital status, or any other protected characteristic. Our management team is dedicated to ensuring full compliance of this policy with respect to recruitment, advertising, hiring, placement, promotion, rates of pay, or other forms of compensation, selection for training, layoffs, termination, and general treatment during employment. All individuals have unique abilities.